Prior Screening for Latent Tuberculosis Among Patients Diagnosed With Tuberculosis Disease: Missed Opportunities?
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
18
08
2023
accepted:
30
10
2023
medline:
29
11
2023
pubmed:
29
11
2023
entrez:
29
11
2023
Statut:
epublish
Résumé
California has the largest number of tuberculosis (TB) disease cases in the United States. This study in a large California health system assessed missed opportunities for latent tuberculosis (LTBI) screening among patients with TB disease. Kaiser Permanente Southern California patients who were ≥18 years old with membership for ≥24 months during the study period from 1 January 2008 to 31 December 2019 were included. Prior LTBI test (tuberculin skin test or interferon-γ release assay) or diagnosis code prior to TB disease diagnosis was assessed among patients with observed TB disease (confirmed by polymerase chain reaction and/or culture). In the absence of current treatment practices, more patients screened for LTBI may have developed TB disease. We estimated hypothetical TB disease cases prevented by multiplying LTBI progression rates by the number of LTBI-positive patients prescribed treatment. A total of 1289 patients with observed TB disease were identified; 148 patients were LTBI positive and 84 were LTBI negative. Patients not prescreened for LTBI made up 82.0% of observed TB disease cases (1057/1289). Adding the hypothetical maximum estimate for prevented cases decreased the percentage of patients who were not prescreened for LTBI to 61.7% [1057/(1289 + 424)]. One-fifth of patients were screened for LTBI prior to their active TB diagnosis. Assuming the upper bound of cases prevented through current screening, almost 62% of TB disease patients were never screened for LTBI. Future work to elucidate gaps in LTBI screening practices and to identify opportunities to improve screening guidelines is needed.
Sections du résumé
Background
UNASSIGNED
California has the largest number of tuberculosis (TB) disease cases in the United States. This study in a large California health system assessed missed opportunities for latent tuberculosis (LTBI) screening among patients with TB disease.
Methods
UNASSIGNED
Kaiser Permanente Southern California patients who were ≥18 years old with membership for ≥24 months during the study period from 1 January 2008 to 31 December 2019 were included. Prior LTBI test (tuberculin skin test or interferon-γ release assay) or diagnosis code prior to TB disease diagnosis was assessed among patients with observed TB disease (confirmed by polymerase chain reaction and/or culture). In the absence of current treatment practices, more patients screened for LTBI may have developed TB disease. We estimated hypothetical TB disease cases prevented by multiplying LTBI progression rates by the number of LTBI-positive patients prescribed treatment.
Results
UNASSIGNED
A total of 1289 patients with observed TB disease were identified; 148 patients were LTBI positive and 84 were LTBI negative. Patients not prescreened for LTBI made up 82.0% of observed TB disease cases (1057/1289). Adding the hypothetical maximum estimate for prevented cases decreased the percentage of patients who were not prescreened for LTBI to 61.7% [1057/(1289 + 424)].
Conclusions
UNASSIGNED
One-fifth of patients were screened for LTBI prior to their active TB diagnosis. Assuming the upper bound of cases prevented through current screening, almost 62% of TB disease patients were never screened for LTBI. Future work to elucidate gaps in LTBI screening practices and to identify opportunities to improve screening guidelines is needed.
Identifiants
pubmed: 38023560
doi: 10.1093/ofid/ofad545
pii: ofad545
pmc: PMC10651207
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofad545Subventions
Organisme : NIAID NIH HHS
ID : R01 AI151072
Pays : United States
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Déclaration de conflit d'intérêts
Potential conflicts of interest. The authors: No reported conflicts of interest.
Références
Vaccine. 2022 Sep 29;40(41):5904-5911
pubmed: 36064668
JAMA. 2008 Jul 23;300(4):405-12
pubmed: 18647983
N Engl J Med. 2021 Dec 9;385(24):2271-2280
pubmed: 34879450
Int J Infect Dis. 2022 Nov;124 Suppl 1:S12-S19
pubmed: 35257904
Am J Public Health. 2015 Sep;105(9):e81-8
pubmed: 26180947
N Engl J Med. 2004 May 13;350(20):2060-7
pubmed: 15141044
Nat Rev Microbiol. 2009 Dec;7(12):845-55
pubmed: 19855401
Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1244-8
pubmed: 9563746
Open Forum Infect Dis. 2023 Apr 21;10(5):ofad219
pubmed: 37265669
MMWR Morb Mortal Wkly Rep. 2017 Mar 24;66(11):295-298
pubmed: 28333913
PLoS One. 2022 Aug 25;17(8):e0273363
pubmed: 36006985
Perm J. 2012 Summer;16(3):37-41
pubmed: 23012597
Breathe (Sheff). 2021 Sep;17(3):210079
pubmed: 35035549
Int J Tuberc Lung Dis. 2006 Oct;10(10):1140-5
pubmed: 17044208
Lancet Infect Dis. 2017 Oct;17(10):e327-e333
pubmed: 28495525
MMWR Morb Mortal Wkly Rep. 2017 Mar 24;66(11):289-294
pubmed: 28333908